Ask Not What Africa CDC Can Do, But What It Can Do Better Than Anyone Else: Five Key Opportunities for the New Director General

On Sunday February 19^th, the 36^th Assembly of Heads of State and Government of the African Union elected Dr Jean Kaseya, a public health physician from the Democratic Republic of Congo, as the new Director General of the Africa Centres for Disease Control and Prevention (Africa CDC). Dr Kaseya will arrive to an institution that rose to prominence during the throes of the COVID-19 pandemic. Africa CDC coordinated the continent-wide response to the disease, became a strong and united voice in negotiations with the international community, and called out harmful practices such as donation of expiring vaccines. His predecessor, founding director Dr John Nkengasong, who stepped down in May 2022, was lauded for his vision, articulated in the New Public Health Order for Africa, as well as his ability to transform political will into unprecedented mechanisms, such as the pan-African Partnership to Accelerate COVID-19 Testing, the Africa Medical Supplies Platform, and the African Vaccine Acquisition Trust.

The world, however, has changed. COVID-19 is no longer the priority that it used to be and there’s a burgeoning fiscal and debt crisis in many African countries. There are also multiple competing priorities vying for the attention of African governments and donors—from accelerating the African Continental Free Trade Area (the main agenda item on the AU Assembly), to addressing climate change and a severe food crises in the horn of Africa.

Amid this backdrop, we identify five key opportunities for Dr Kaseya as he takes the helm of the continent’s leading public health agency:

1. Articulate a clear and prioritised vision for Africa CDC: the leading role played by Africa CDC in the response to the pandemic, aid localization, and the greater role expected from regional organizations have made Africa CDC a sought-after institution. Several donors including the World Bank, the European Union, the US government, the Bill & Melinda Gates Foundation, and the Mastercard Foundation, to name a few, have already provided funding to Africa CDC. Each of these organizations, however well intentioned, will bring with them different perspectives regarding the priorities for Africa CDC. African governments are also eager to engage with, and receive support from Africa CDC, in a wide variety of areas—from how to strengthen their laboratory systems to identifying the best path to universal health coverage. The new Director General will therefore be faced with plethora of potential priorities, from both donors and member states. But Dr Kaseya must be the one to articulate a clear vision for the Africa CDC, one highly focused on its areas of comparative advantage. Determining priorities is as much about saying no as it is about saying yes. If everything’s a priority, then nothing is. 
2. Focus on comparative advantage to maximize impact: Africa CDC has a natural comparative advantage, and a successful track record focused on technical infectious disease areas, such as developing cross-country genomic surveillance systems and tracking regional outbreaks. It also has a comparative advantage on producing regional public goods, such as data repositories and regional health technology assessments. However, Dr Kaseya will also want to build on its primary and unique source of strength—the legitimacy and authority conferred to it by the AU and member states. This comparative advantage enables it unparalleled convening power, high level diplomatic influence, and access to the AU Commission and political leadership of its 55 member states. Critically, it enables it to legitimately represent and lead on continental health issues, and promote common solutions to difficult collective action issues, as exemplified by the African Vaccine Acquisition Trust. Dr Kaseya will need to decide which controversial issues to tackle with this influential backing. It might include regional vaccine manufacturing, declarations of regional public health emergencies, and legally binding frameworks for pandemic preparedness and response. Each of these are controversial and have interest groups that will push Africa CDC in specific directions—he will have to choose wisely which to take on.
3. Secure financial sustainability and autonomy from donors to ensure the agency is agile and independent: Africa CDC is predominantly led by seconded staff, and funded by donors, which is in tension with the vision of an autonomous agency leading the New Public Health Order. The new Director General will have the opportunity to make the case for further unrestricted funding from donors as part of the respectful, action-oriented partnership that Africa CDC has called for. This will not be easy, as levels of funding to Africa CDC could slow down as pandemic-related funding wanes. Additionally, he will need to rally the AU and African governments to gradually increase their financial contributions to build a financially independent, robust agency that primarily answers to member states rather than external actors. Dr Kaseya must also seize on the opportunity to successfully deliver on the Africa CDC’s transformation from a specialized technical institution, to an autonomous public health agency approved by the AU in 2022. This will involve setting up efficient administrative and support structures, from human resource management, to procurement and finance systems. Dr Kaseya can also take up the opportunity to deliver on the absolute gender equality rule adopted by the AU in 2002. On paper, Africa CDC has the legal, institutional, and operational autonomy to be more agile and independent in decision-making. It also has the mandate to have gender parity rule. The new Director General can translate paper to reality.
4. Proactively decentralize and reset the continental/regional balance: Africa CDC started with an admirable decentralized vision, but this has not been fully realized, perhaps because its meteoric rise during COVID-19 led to a top-down approach with focus on a strong headquarters in Addis Ababa. The new Director General can change that by truly operationalizing the Regional Coordinating Centres (RCCs) and deepening the partnership with its member national public health institutions. This move would help Africa CDC to implement its mandate (because in the end, it works through member states to achieve its objectives); it would also help the institution understand the realities on the ground and gather ideas on what works and what doesn’t. RCCs can also develop regional public goods that can then be replicated or amplified at the continental level. Finally, RCCs will help Africa CDC establish adequate working relationships with the Regional Economic Communities, a necessary move as the AU moves towards regional economic integration and the African Continental Free Trade Area.
5. Place Africa CDC within the global health architecture. Lastly, and perhaps most challenging, Dr Kaseya will have the opportunity to continue to establish the place of Africa CDC in the global health architecture, but must do so in a way that is measured and collaborative. How should it relate to the Global Fund, the World Bank, the African Development Bank, or PEPFAR? How can its Health Economics Programme guide donor initiatives on continental value for money? What protocols should it follow in declaration of a “Public Health Emergency of Continental Security?” How can it leverage the emerging regional cohesion to be a united African voice on key global discussions, such as the Pandemic Treaty? Its rise has most visibly brought it into tension with the WHO Regional Office for Africa. There are paths ahead that involve conflict and power grabs, and others that involve partnerships, allocation of roles (and funding) according to comparative advantage, and a resultant gain in regional public health and global health security. Some conflict, however, is a necessary reset of historic power imbalances as part of the New Public Health Order. For example, Africa CDC is right to point out that it should be an implementing partner of the Pandemic Fund. How Dr Kaseya approaches these strategic choices will be one of the defining tests of his leadership and will shape Africa CDC for years to come.

John Nkengasong has left a remarkable founder’s legacy, leading a dynamic new start-up, with inspiring vision and potential. But it will be Dr Kaseya who will take the organization through its next phase, maturing and decentralizing its newly independent structures, consolidating and prioritizing its work around its comparative advantages, ensuring its independence and sustainability, and establishing its long-term place in the global health architecture. We wish him well.